Rosacea

This disease is typical of young or adult women with low phototypes (I and II). It can also be observed in men, although usually later and with a greater tendency to present phymatous rosacea (growth of the soft tissue of the nose). In 20% of cases, we can find a family history.

There are 4 types of rosacea and patients may present with one or multiple of these variants.

• Erythematous-telangiectatic rosacea: Presence of diffuse redness and dilated vessels (telangiectasias) especially affecting the cheeks and nose, which respond easily to external factors.
• Papulo-pustular rosacea: Presence of inflammatory lesions in the form of papules and pustules. These lesions are similar to acne, although in rosacea we do not observe comedones or scars.
• Phymatous rosacea: the most typical case is rhinophyma, a thickening of the soft tissue of the nose that especially affects men.
• Other types: ocular rosacea, granulomatous rosacea, rosacea fulminans, etc. These types are less frequent and require a specific approach.

There is a familial predisposition for the development of this disease. In addition, other factors are involved such as hyperfunction of the sebaceous gland which acts as an irritant factor, chronic inflammation and tendency to redness (couperosis and flushing), and an alteration of the barrier function and the skin microbiome (favoring the proliferation of Demodex folliculorum).

Among the classic factors that can worsen rosacea in any of its forms are stress, exposure to ultraviolet radiation, the use of certain cosmetics or the ingestion of certain foods (alcohol, spicy foods, foods at high temperatures, etc).

The diagnosis of rosacea must be made by a dermatologist and is the key to deciding on the most appropriate treatment. In most cases, this diagnosis will be clinical, that is to say, it will be necessary to examine the skin and take a good clinical history. In doubtful cases a skin biopsy may be necessary, although this is rare.

There are different treatments available, and to achieve optimal results it may be necessary to combine some of them:

• Proper cosmetic routine. Personalised selection of cosmetics can help to enhance the other treatments and maintain their long-term effects, preventing or controlling disease outbreaks. However, their exclusive use is often insufficient to control the disease.
• Topical treatments such as topical ivermectin, which can be helpful in cases of demodecidosis (overgrowth and inflammation caused by Demodex).
• Oral treatments such as certain antibiotics (tetracyclines) or oral retinoids (isotretinoin). The latter reduces sebum production by reducing the size of the sebaceous gland and controlling the inflammation of rosacea.
• Lasers and light sources. The use of pulsed light, pulsed dye laser or KTP can be helpful in controlling the inflammatory component, telangiectasias and flushing.

Rosacea is a chronic disease that can be effectively controlled with specific treatment. This does not prevent the appearance of future outbreaks, but it can reduce their number and severity.